Spigelian hernia

[Linh]

Dear Steve,

I had a patient with high BMI with no prior surgery. She complained of a lump when standing erect on the left anterior abdo wall. I found a mushroom shaped hernia with fat moving through a neck.

However, due to the high BMI, I cannot identify the oblique muscles and the Rectus abdominis is very hard to see as it is very thin (stretched out) and I was using the curve 10C3 probe. Apart from Spigelian hernia, is there any other types of hernia at this location that I need to be aware of when calling this hernia a Spigelian type?

Best regards,
Linh

• This topic was modified 3 years, 11 months ago by Linh.

[Stephen Bird]

These cases are tricky,

It may well be spigelian but also consider that it might be a ventral hernia through the linea alba where the linea alba is very wide due to the abdominal wall musculature weakness.
Ventral hernias through the linea alba are much more common than spigelian so I would bet on this one first . The fact that it is not in the midline is fine for this type of patient.

CT scan of the abdomen will settle the argument if you have any doubt.

Steve

[Linh]

Thanks Steve,

I measure the distance from the umbilicus to that hernia: 20cm to the left and 8cm sup to umb. I think it is a Spigelian but thanks for letting me know the differentials to be aware of. I almost called it NAD since I cannot see that hernia when patient was lying down.

[Stephen Bird]

They can be tricky,

I think you have made the correct measurements.

All abdominal hernias are more pronounced when the patient is standing. I have a tilting bed so I can put it at 60 degrees allowing for good gravitational pressure and a stable scanning position,

Steve

[Linh]

Oh nice. Ergonomics is not stressed enough these days as the population is getting heavier!

[Stephen Bird]

Agreed,

I think the main thing with ergonomics above all others is to prevent unsupported abduction of the shoulder.
If you can prevent this I think your scanning technique will be robust and safe for the long haul.

Steve

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